Blog | Thursday, November 16, 2017

Why are you seeing a gastroenterologist?


I write to you now from the west side of Cleveland in a coffee shop with my legs perched upon a chair. Just finished the last op-ed of interest in the New York Times. Do I sound relaxed?

I rounded this morning at both of the community hospitals that we serve. There is not a day that goes by that doesn't have blogworthy moments. If I had the time and the talent, I would post daily instead of weekly. Read on for yet another true medical insider's disclosure.

Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients. For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding, and various other symptoms. The same process occurs when we are called to see hospital patients. If a hospital admitting physician, who is usually a hospitalist, wants an opinion or a test that is beyond his knowledge or skill level, then we are called in to assist.

The highest quality referring physicians are those who ask us a specific question after they have given the issue considerable thought. Contrast the following three scenarios and decide which referring physician you would select as your own doctor.
• “Dr. Gastro. Just met this patient for the first time with a month of stomach aches. Please evaluate.”
• “Why did your doctor send you here?” queried Dr. Gastro to the patient. “No idea,” responded the patient.
• “Dr. Gastro, please evaluate my patient with upper abdominal pain. I thought it might be an ulcer, but the pain has not changed after a month of ulcer medication. The pain is not typical of the usual abdominal conditions we see. Do you think a CAT scan of the abdomen or a scope exam of the stomach would be the next step? Open to your suggestions.”

As readers can surmise, I favor primary care and referring physicians who give thought prior to consulting me. There are many reasons today why primary care physicians pull the specialty consult trigger quickly. Sometimes, busy internists simply don't have the time available to deeply contemplate patients' symptoms. Physicians have also referred patients to specialists with the hope of gaining litigation protection by passing the patient up the chain, although the medical malpractice crusade has eased over the past few years. Oftentimes, patients drive the specialty consultation process by asking to be sent to specialists.

More often than you would think, we see patients in our office or in the hospital when neither the patient nor I have a clue why they are there. This adds excitement to our task. In addition to being diagnosticians, we must also serve as detectives, divining the reason that the patient is before us!

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.